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The Virginia Workers’ Compensation Commission: Claims Processes

The Commission has two primary functions with respect to administering benefits.

Under the Virginia Workers’ Compensation Act. The first is to process claims. The second is to adjudicate claims. Here’s a quick summary of the process part. The adjudication part is in a second blog.

The first function is establishing and monitoring claims seeking benefits under the Act.

  • Worker Claims. The Commission, on receipt of an injury report or notification of an occupational illness will prepare a claim file. A claim for benefits will also cause the Commission to create a claim file. Claims must be filed within two years of the date of the accident or the injured worker will risk losing any and all benefits. A dispute can also generate a claim file.
  • Health Care Provider Claims. Health care providers can also submit claims when the insurance company declines or fails to pay a bill or where the provider disputes the amount of payment. Health care provide claims are not the same as work injury claim – but both are handled by the Commission.

 

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